Dr. Pepper

I actually made 5 gallons of IPA last night. Hopefully it is starting to ferment as we speak.

I will be doing the 3:30 talk on 10/20 on "The Chemistry of Beer". Should be fun.

Ditto on Terri, particularly #1. I consider it a bargain for the price of 9 or so units of RBC. Use blood management practices to avoid 9 transfusions and it's paid for. Phil

There are always things that make you scratch your head a bit, that you dare not go above 6o for a second during storage, but that 10o is fine during shipping. Or that you cannot send RhIG through the pneumatic tube because it might be subjected to undue turbulance, but the shipper can kick the hell out of it and throw it in the back of a truck with bad shocks to jiggle along a bumpy road on its way to you.

Here's the entire manual scanned. Immufuge Manual.pdf

Our lab (not the BB of course) messed up with our hospitals president's auntie's spec one time, had to get her redrawn. Oops.

Agree with David. The 30 minute rule was for glass bottles or fat units of whole blood. If you try it yourself with an outdated or mock unit of packed cells you get 15-17 minutes at best. The myth was perpetuated by AABB for years by a sentence in the Tech Manual that went something like "Many facilities use a 30 minute limit ........." Hasn't been in there for a while. We just take the temp of the unit when it returns.

Ditto to R1R2. If the patient needs more blood, we use the original spec. If we need to use the post-rxn spec over the next 3 days, we will do a screen on that spec and proceed as with any other. If the patient needs more blood before the initial investigation is completed, we get a release from the MD. If it shows no evidence of hemolysis, we proceed as above. If it does (pos DAT, say) we get a release if the patient needs more blood before we complete a comprehensive exam.

We have a surgeon or two (who have their patients donate their own blood or use the cell saver indiscriminately) who still seem to think the quality of our blood components is sh***y, so why gve them more reason to?

I think this code is for pretreating cells (DTT, enzymes, coating with antibiotics etc) prior to testing, not for just adding an enhancement medium to your tests. It's a seperate step done to get your cells ready for whatever test you are going to perform. I would not use it under these circumstances.

Exactly exactly exactly. The last thing we want is physicians in their infinate wisdom to gloss over a fever due to a hemolytic reaction because they thought the patient was going to spike a temp then anyway.

I think so. In our elution test battery (Meditech) we have a bill only test for the 86860, a "Antibody Eluted from Pt's Cells" antibody-ID type test where the results get reported and the Ab ID CPT code tacked on, and we should add a bill only code for the screen on the last wash as well. Thank you very much.

I will be presenting at the conference. I would love to meet any of the BBT crew who might be attending. Phil

Terri, this is a great, succinct form. I love it. I wonder, though, if any physician other than a blood bank one would have the faintest idea what it was talking about.

Sorry about the delay in response. Continuous (unlike me).

While we have everyone's attention here, can anyone explain the mechanism whereby freezing and thawing cells a la Lui shaves off the antibody? I would think you would end up with a bunch of stroma with antibody still attached.

No regs to retain blank copies that I'm aware of HOWEVER there's a great practical reason: to easily make more copies when someone has used the last one. Nothing more annoying than having to make a copy of one that has been used, whiting out reactions and literally cutting and pasting parts of another form on there. If you have electronic access to blanks that's easier, but still not as easy as making a photocopy. As soon as a new lot of screening/panel cells comes in, we pop a blank into a notebook to be used if needed. When it starts getting full I toss some out. Easy peasy.

Assuming you don't have gel or solid phase, that leaves you in a tube (like us). I would use LISS or PeG. PeG is in general more sensitive, particularly with Rh and Kidd system antibodies. Some years ago we trialed PeG extensively before settling on LISS for routine use. While the added sensitivity was nice, it was also very good at enhancing autoantibodies and some colds. We also found occasional specs which showed weak, unspecified reactivity which we could not replicate with other techniques, even sending it to a neighbor to test in gel. There can be difficulties in testing plasma with PeG. So we stuck with LISS. We keep PeG on hand to use with weak antibodies which may be hard to pin a specificity on with LISS, for non-RBC antibody problems with something in the LISS formulation, to enhance eluates from weak positive DATs, and to do autoadsorptions. I wouldn't worry about not being able to read PeG at 37o. If it's significant you should see it in AHG. My advice would be to pick one or the other to use routinely, and keep the other on hand as a backup in case you have some technical issues with the routine methodology.

Kind of stops around the V. I was just being a little silly. We do call it electronic crossmatch, although I teach that it is really CVOABOC.

Thanks to CVOABOC (computerized-verification-of-ABO-compatibility), our number of crossmatches has dropped down a lot. We do pretty much like Bankergirl does, and hold them like Dave does. We rarely double crossmatch - but then, we rarely crossmatch ahead of time unless it's serologic. I wonder how comfortable the rest of the medical world would be if they realized what we sometimes do, or don't do, to get that "COMPATIBLE" unit of blood: adsorptions, neutralizations, flat out ignoring positive reactions at IS, or, in most cases, not even getting a test tube wet! Ignorance surely is bliss.

Thankfully our pneumatic tube has rigid dietary restrictions and this is not an issue.

Thank you Dave. Unfortunately, my fridge and freezer just increment the temp. Thank you Terri, that is what I was going to try. I have the alarms set to sound immediately. And the good Lord giveth, the good Lord taketh away - our FFP freezer died last night, although a valiant attempt at resuscitation and/or resurrection will be made today.

Does anyone know if AABB and CAP are OK with letting your fridge or freezer, if so equipped, electronically test high and low activation temps, rather than doing the old put the probes in a bucket and slowly add cold or warm water method? One would think that if your digital readout is calibrated as accurate, this should suffice, and certainly be easier. This has come up because we are the proud owners of a new Helmer platelet incubator (and thus losing our distinction of being the only BB in the western hemisphere to lack one) where the old method is not practical because the thermocouple is fixed to the wall. The service manual offers two methods of checking: electronically (the box warms or cools the probe), or manually with a 16x100 tube that they tell you fill with hot or cold water and slip up over the probe. (There is a bracket to guide the tube that prevents you from using any other larger container to do so.) In both cases the temperature change was rapid enough to change the digital temp in increments of 0.4o or so and it was hard to see the exact temperature that the alarms were activated. I have the high and low set for 20.5 and 23.5. I think I might try starting with water in the safe zone and add ice water or hot water drop by drop to get a more gradual change and find exactly where they go off. Or just be satisfied as long as they go off above 20.0 and below 24.0. What do you folks do? Thanks - Phil

PeG can precipitate plasma proteins. You may have better results with serum. We use 12x75 tubes and usually have no problems with our old Centra W cell washers x 4 washes. Once in a while we might have to add an extra wash. We have also seen rare patients who just don't want to check no matter what you use for enhancement. One we actually had to wash through 3 cycles of 4 washes before the cells would check. You hope the antibody hangs on tight.

Agree with Scott and Goodchild. Another wrinkle on this is that CAP and AABB both want you to do what your own P&P states. Whatever the issue is, it may not be required as a specific standard or checklist item, but you still need to stay true to yourself.